Fixed combinations in the management of hypertension: patient perspectives and rationale for development and utility of the olmesartan – amlodipine combination

Figures & data

Figure 1 Algorithm for treatment of hypertension. BP, blood pressure. Modified from Chobanian et al (2003).

Figure 2 Effect of fixed-dose combinations versus free-drug combination on the risk of medication nonadherence in cohort with hypertension. Reprinted from Bangalore S, Kamalakkannan G, Parkar S, et al 2007. Fixed-dose combinations improve medication compliance: a meta-analysis. Am J Med 120:713–19. Copyright © 2007, with permission from Elsevier.

Table 1 Advantages of fixed-dose combination therapy

Increased compliance, simplified titration, and convenience of use. Potentiation of antihypertensive effects of single compounds. Additive or synergistic effects. Enhancing effect in specific populations. Attenuation in adverse events. Decreases in diuretic-induced metabolic changes with ACE inhibitors or ARBs. Decrease in calcium channel anatagonist-related peripheral edema with ACE inhibitors or ARB. Improved overall results, greater BP response, and lower cost.

Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker; BP, blood pressure.

Figure 3 Medication adherence with combination of amlodipine/benazepril singletablet compared to same combination as separate components.

Table 2 Currently available combination antihypertensives in US in 2007

ACE inhibitors and diuretics

Benazepril – HCTZ Captopril – HCTZ Enalapril – HCTZ Lisinopril – HCTZ Fosinopril – HCTZ Quinapril – HCTZ Moexipril – HCTZ

ARBs and diuretics

Losartan – HCTZ Valsartan – HCTZ Irbesartan – HCTZ Telmisartan – HCTZ Olmesartan – HCTZ Candesartan – HCTZ Eprosartan – HCTZ

Potassium-sparing diuretics and HCTZ

Amiloride – HCTZ Spironolactone – HCTZ Triamterene – HCTZ

BBs and diuretics

Metoprolol – HCTZ Timolol – HCTZ Atenolol – Chlorthalidone Bisoprolol – HCTZ Nadolol – Bendroflumethiazide Propranolol – HCTZ

ACE inhibitors and CCB

Enalapril – Diltiazem Benazepril – Amlodipine Enalapril – Felodipine Trandolapril – Verapamil

ARBs and CCBs

Valsartan – Amlodipine Olmesartan – Amlodipine

Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin II receptor blocker; BB, β-blockers; CCB, calcium-channel blockers; HCTZ, hydrochlorothiazide.

Figure 4 Reduction (model fitted) in seated systolic blood pressure (SBP) (upper panel) and seated diastolic blood pressure (DBP) (lower panel) for 12 groups in the factorial design by olmesartan medoxomil and hydrochlorothiazide (HCTZ) dosage. Adapted by permission from Macmillan Publishers Ltd: Chrysant SG, Weber MA, Wang AC, et al 2004. Evaluation of antihypertensive therapy with combination of olmesartan medoxomil and hydrochlorothiazide. Am J Hypertens 17:252-9. Copyright © 2004.

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